PB2196: CLINICAL IMPACT OF NUTRITIONAL STATUS AND NUTRITIONAL MONITORING IN PRIMARY MYELOFIBROSIS PATIENTS: PRELIMINARY RESULTS OF NUTRIMY STUDY
Authors: Margherita Malchiodi, Camilla Baldoni, Adele Santoni, Anna Sicuranza, Valentina Venanzi, Corrado Zuanelli Brambilla, Elisabetta Zappone, Marzia Defina, Monica Bocchia
Journal: HemaSphere (2023)

Topic: 16. Myeloproliferative neoplasms - Clinical Background: Primary myelofibrosis (PMF) is a myeloproliferative neoplasm (MPN) characterized by stem cell-derived clonal proliferation that is often associated with driver mutations (JAK2, CALR, or MPL) or subclonal mutations and fibrosis on bone marrow biopsy. PMF clinical manifestations responsible of a poor quality of life (QoL) include splenomegaly and anemia, that together with a high inflammatory cytokine status, induce constitutional symptoms (fatigue, night sweats, itching, fever and cachexia). This condition leads often to an unintentional weight loss and a change in appetite. For this reason, the evaluation of nutritional status in PMF patients (pts) could play a crucial role on the pursuit of wellness. Up to date, studies exploring the influence of dietary factors in this setting of pts have not been performed yet. Aims: The aim of prospective NUTRIMY study is two-fold: first, to extensively evaluate dietary, nutritional changes and QoL as part of an all-round assessment of PMF pts; second, to test the efficacy of an optimized nutritional support in improving clinical outcomes and QoL of these pts. Methods: At baseline PMF pts enrolled in the study are assessed for general patient-specific, disease-specific, significant comorbidities. Additionally, NRS-2002 nutritional risk screening, a tool associated with short-term and long-term clinical outcomes, is performed. Dietary behavior and Nutritional status monitoring are collected at baseline and every 3 months by a dedicated dietitian using the following specific tools: physical/anthropometric parameters (body mass index); nutritional-oriented serum chemistry panel (albumin, total cholesterol, transferrin, ferritin); Bioimpedance analysis, including calculation of Skeletal Muscle Mass Index and phase angle. During routinary visit, two MPN-specific QoL questionnaires (Mesa R. et al. Hematol Oncol Clin North Am. 2021) are also administered. Results: Up to now, a total of 22 PMF pts (15 female and 7 male) with a median age of 73 years (range 46-89 yrs) have been enrolled. At baseline, median hemoglobin was 12,4 (10,3 – 14,3) g/dl, but in 7/22 pts (31,8%) it has been supported by erythropoiesis- stimulating agent. Splenomegaly (spleen size > 10 cm) was present in 15/22 pts (68,2%) and 17/22 pts (77,3%) experienced constitutional symptoms. Nutritional risk at enrollment, expressed by NRS-2002 score, resulted high (≥3) in 18/22 pts (81,8%). In all cohort the macronutrient distribution resulted inadequate and 10/22 pts (45,5%) suffered of early satiety. BMI stratification identified 3 different categories: 4/22 pts (18,2%) were underweight (BMI < 19 kg/m2), 8/22 pts (36,4%) were healthy weight (BMI 19-25 kg/m2) and 10/22 (45,4%) were overweight (BMI > 25 kg/m2). In each category at baseline, we also analyzed Fat Free Mass (FFM), Fat Mass (FM), Body Cell Mass Index (BCM) and Phase Angle that are summarized in Table 1. Up today, 9/22 pts reached three months of specific nutritional support and repeated bioimpedance analysis showing already an improvement (Table 1). Summary/Conclusion: Preliminary results showed that an inadequate nutritional status is a common event in PMF patients, together with an unbalanced diet and that a specific nutritional support is of benefit even after a short time of intervention. This could have an important impact on the overall wellness of PMF pts. The study accrual is ongoing as well as clinical, biologic and QoL data collecting to prove this hypothesis. Table 1Keywords: Quality of life, Myelofibrosis